Ommaya 储库在小儿 ALL 和 NHL 中的应用:圣裘德儿童研究医院的综述。

IF 2.7 4区 医学 Q3 ONCOLOGY Cancer Chemotherapy and Pharmacology Pub Date : 2024-06-01 Epub Date: 2024-02-28 DOI:10.1007/s00280-024-04653-9
Alyssa Gaietto, John C Panetta, Jennifer L Pauley, Mary V Relling, Raul Ribeiro, Matthew J Ehrhardt, Ching-Hon Pui, Hiroto Inaba, Hope D Swanson
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引用次数: 0

摘要

目的:与更常用的鞘内给药相比,通过 Ommaya Reservoir(OmR)进行的静脉内化疗途径可改善药物在中枢神经系统(CNS)中的分布。我们回顾总结了急性淋巴细胞白血病(ALL)和非霍奇金淋巴瘤(NHL)患者的静脉内化疗经验,重点是甲氨蝶呤:在1990年至2019年期间,共对24名患者(年龄在7天至22.2岁之间)进行了26次OmR治疗,总计25009个OmR日。分析了 15 名患者 59 个 OmR 治疗疗程的甲氨蝶呤脑脊液(CSF)浓度(n = 124)。其中 21 个疗程仅在第 0 天服用甲氨蝶呤,38 个疗程在第 1 天、第 2 天或第 2 天同时服用甲氨蝶呤。我们模拟了不同给药方案下 CSF 甲氨蝶呤浓度在 3 天内保持 > 1 µM 的时间:结果:同时接受全身甲氨蝶呤治疗的患者的脑脊液甲氨蝶呤暴露量高于单独接受 OmR 治疗的患者(p - 7)。我们的模拟结果表明,对于年龄≥ 3 岁的患者,目前的脑室内甲氨蝶呤升压策略可在 40% 的时间内使脑脊液甲氨蝶呤浓度在 72 小时内保持≥ 1 µM。另外,根据预测,其他升压策略可在 46% 到 72% 的时间内使 CSF 甲氨蝶呤浓度在 72 小时内≥ 1 µM:对于 7 天至 22 岁的患者,OmR 可以安全放置,并在使用或不使用增强剂量的情况下进行静脉注射甲氨蝶呤。预计增量策略可在 72 小时内使 CSF 甲氨蝶呤浓度≥ 1 µM。
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Ommaya reservoir use in pediatric ALL and NHL: a review at St. Jude Children's Research Hospital.

Purpose: The intraventricular route of chemotherapy administration, via an Ommaya Reservoir (OmR) improves drug distribution in the central nervous system (CNS) compared to the more commonly used intrathecal administration. We retrospectively reviewed our experience with intraventricular chemotherapy, focused on methotrexate, in patients with Acute Lymphoblastic Leukemia (ALL) and Non-Hodgkin Lymphoma (NHL).

Methods: Twenty-four patients (aged 7 days - 22.2 years) with 26 OmR placements were identified for a total of 25,009 OmR days between 1990 and 2019. Methotrexate cerebrospinal fluid (CSF) concentrations (n = 124) were analyzed from 59 courses of OmR therapy in 15 patients. Twenty-one courses involved methotrexate dosing on day 0 only, whereas 38 courses involved booster dosing on days 1, 2, or both. We simulated the time CSF methotrexate concentrations remained > 1 µM for 3 days given various dosing regimens.

Results: CSF methotrexate exposure was higher in those who concurrently received systemic methotrexate than via OmR alone (p < 10- 7). Our simulations showed that current intraventricular methotrexate boosting strategy for patients ≥ 3 years of age maintained CSF methotrexate concentrations ≥ 1 µM for 72 h 40% of the time. Alternatively, other boosting strategies were predicted to achieve CSF methotrexate concentrations ≥ 1 µM for 72 h between 46 and 72% of the time.

Conclusions: OmR were able to be safely placed and administer intraventricular methotrexate with and without boost doses in patients from 7 days to 22 years old. Boosting strategies are predicted to increase CSF methotrexate concentrations ≥ 1 µM for 72 h.

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来源期刊
CiteScore
6.10
自引率
3.30%
发文量
116
审稿时长
2.5 months
期刊介绍: Addressing a wide range of pharmacologic and oncologic concerns on both experimental and clinical levels, Cancer Chemotherapy and Pharmacology is an eminent journal in the field. The primary focus in this rapid publication medium is on new anticancer agents, their experimental screening, preclinical toxicology and pharmacology, single and combined drug administration modalities, and clinical phase I, II and III trials. It is essential reading for pharmacologists and oncologists giving results recorded in the following areas: clinical toxicology, pharmacokinetics, pharmacodynamics, drug interactions, and indications for chemotherapy in cancer treatment strategy.
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